Is it incongruous, and maybe even a little irresponsible, for governments to introduce costly new health programs without knowing, or telling, taxpayers what they might cost?

After making a splashy announcement that the BC government will soon implement a new colorectal cancer screening program (like cervical or breast cancer screening) for all those in the 50 to 74 year old age group, health minister Margaret MacDiarmid made the rather surprising admission that she has no idea what it would cost. Not even a clue about whether it might be $70 million or $100 million a year, figures which equate to about double or triple what the province is already spending on colon cancer screening, on an ad hoc basis.

About 230,000 BC residents provided a stool sample test looking for signs of blood from cancerous or pre-cancerous growths last year. But there are about 1.4 million people who are in the 50 to 74 age group who will be sent regular reminders to get tested through the new program. So it’s easy to imagine that costs will rise exponentially.

After covering the announcement and writing this article, I pressed the government for more information about the missing cost projections. This is what I was told by health ministry spokesman Stephen May:

We will be negotiating the fees for the fecal immunochemical test with the BCMA tariff committee – as we would with any fee item. Until that is complete it is premature to speculate on costs.

The practitioner, specialist and lab fees will be paid out through our Medical Services Plan, and that cost will depend on how many patients participate in the program.

Actual program expenditures will depend primarily on the level of patient participation and the cost of the fecal immunochemical test; however, we are committed to allocating the necessary funding resources towards supporting the new screening program. This includes:

Promoting public awareness, developing a centralized participant registry and developing a system for data collection and monitoring;

General practitioner and specialist (colonoscopist) fees and laboratory fees for the fecal immunochemical test; and,

Colonoscopy screening and pathology laboratory cost requirements.

Then I asked Opposition Leader Adrian Dix for his perspective on this matter. The NDP leader, who has been a tireless

BC NDP leader Adrian Dix. (Photo credit: Wikipedia)

advocate for such a program (partly because of his mom’s history with the disease), said the way government announced the program was definitely unusual.

“The key issue is that they would have had cost estimates for at least five years, based on what other provinces have been doing and what the BC Cancer Agency has been modelling. Don’t get me wrong, I’m delighted they’ve gone ahead with this program, but the fact that they didn’t work out certain costs ahead of time suggests they decided to do this rather recently. That means that to some degree, it was a political announcement, and that’s fair enough…but you have to have a clear idea of what you’re doing when announcing a program like this…otherwise, it has the appearance of being a rash announcement.”

But Dix said he thinks government must, at the very least, have a concept of cost projections.

“In general, you have to go to Treasury Board with some numbers showing that you are publicly committed to something, and with the understanding that the numbers may need to be refined. My general idea is that they have to have a pretty good idea, unless they have given up all fiscal control and I don’t think that is the case.”

In our phone chat, Dix also expressed dismay over the fact that it announced the program before working out medical, lab fees and test kit costs.

“I think it’s disconcerting … they didn’t negotiate these costs first. You can only strengthen your position if you negotiate (bulk purchasing and fee deals) first.”

Dix more or less echoed MacDiarmid’s sentiments on that point and said even if the cost of colorectal cancer screening doubles, there will be cost benefits in the sense that cancers caught earlier cost less to treat.

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